Individual
KIM GONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2726 ALDERWOOD AVE, BELLINGHAM, WA 98225-1223
(360) 733-2322
Mailing address
1534 FRANKLIN ST APT 1, BELLINGHAM, WA 98225-4966
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02763624
—
WA
Enumeration date
07/31/2017
Last updated
07/31/2017
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